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HomeMy WebLinkAboutNCC211143_NOI Application_20210226Action History (UTC-05:00) Eastern Time (US & Canada) Subrrit by Anonymous User 2/24/2021 11:52:43 AM (NCG01 NOI Submission) Approve by Gamble, Aana C 2/25/2021 9:25:58 AM (Review- Construction NOI 45298) • The task was assigned to Gamble, Aana C by round robin distribution 2/24/2021 11:53 AM The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 26, 2021 5:00 PM 2/24/2021 11:53 AM Submit by Selkane, Aziza 2/26/2021 10:43:53 AM (Payment Verification for NCC211143) * Green Engineering, PLLC • Selkane, Aziza assigned the task to Selkane, Aziza 2/26/2021 10:42 AM The task was assigned to DEMLR NCG01 Payment Team. The due date is: April 8, 2021 5:00 PM 2/25/2021 9:26 AM .• SThF� '; 1 NORTH CAROLINA EnrlronmertW quallly A. Project Information Part A. Project Location and Waterbody Information Are you submitting IT No an NOI that was r Yes rejected before? 1a. Project Name * Hwy 301 Commercial Center 1 b. Specific Lot This field rray be used to list specifc lot nunbers. Numbers 1 c. Parcel ID List all Rios associated w ith this project. Number(s) (PIN) 3711-82-5521 3711-92-2100 3711-82-9276 3711-82-8064 3711-82-8530 2. County* Wilson 3. Highway or Street 1911 U.S. Hwy 301 South Address* Street name only is acceptable if no address nunber assigned yet 4. Cityor Township* Wilson 5. State * NC 6. Zip Code* 27893 7. Latitude* Enter the latitude in decinal degrees 35.7033 8. Longitude * Enter the longitude in decinal degrees (MBTbe negative) -77.9269 If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of North Carolina. Look for the coordinates in the bottom left corner. 9. Date to Begin* 03/01/2021 Estir ated Construction Project Start Date 10. Date to End * 09/30/2021 Estinated Construction Project End Date 11. SIC (Primary)* Commercial (1542) Standard Industrial aassification for Development 12. Acres to be 10.30 disturbed* (including off -site borrow and waste areas) 13. Total site area 9.65 (acres) * 14. Post- 2.94 construction (Estimated) impervious area (acres) * NCC Project NCC-WILSO-2021-Hwy 301 Commercial Center Tracking ID Assigned automatically Below you must enter waterbody information for surface waters affected by this project. Please consult DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You may enter up to 3 waterbodies if needed. 15a. Receiving UT to Hominy Swamp Wate rbody* %rre of waterbody into which stormwater runoff will discharge 15b. Waterbody 27-86-8 Index No.* NCWaterbody Index Number Stormwater rJ No discharges will flow r- Yes to additional wate rs * 16a. Is this project r Yes subject to the NC r No, not subject to NC SPCA Sediment Pollution Control Act?* B. Permittee Information Part B. ^ F2rnittee Inforrration - Legally Fbsponsible Entity and Individual Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same organization. That person must be a responsible corporate officer who owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. 1. Organization Legally Pesponsible Entity Name * Sleepy Hollow Development Company It pernittee is an individual (i.e., organization does not apply), enter first and last narre in this field. Note: The organization name must match the business entity name registered with the NC Secretary of State. You can verify the registration here. 2. First Name * Ralph If Corporation, enter Faegistered Agent First %rre 3. Last Name* Hodge It Corporation, enter Pbegistered Agent Last %rre 3b. Title President 4. Permitee E-mail ralph@ralphhodge.com Address* 5. Permittee 252-237-8134 Telephone No.* 6. Permittee Mailing Street Address Address* 2101 Miller Rd. S. Address Line 2 City Wilson Fbstal / Zip Code 27893 Check box if the street address the same as mailing address 7. Permittee Street Address* V Yes Street Address 2101 Miller Rd. S. Address Line 2 city Wilson Fbstal / Zip Code 27893 State / Frovince / Fbgion NC Country us State / Frovince / Faegion NC Country us 8. Type of Ojvnership is only individual if an individual is naned in B.1. above. Ownership* Non -Government C. Site Contact Information Part C. Roject Site Contact Inforrration .................................................................................................................................................................................................... 1. Primary Site Ralph Contact - First Name * 2. Primary Site Hodge Contact - Last Name * 3. Title President 4. Site Contact E- ralph@ralphhodge.com mail Address* 5. Site Contact 252-237-8134 Telephone No. 6. Organization Sleepy Hollow Development Company Name 7. Site Contact Street Address Mailing Address* 2101 Miller Rd. S Address Line 2 city Wilson Postal / Zip Code 27893 8. Consultant Name (Optional) Jon Meade (Green Engineering) First and Last nacre 9. Consultant E-mail j.meade@greeneng.com This person will be copied on all correspondence. 10. Consultant 2522375365 Telephone No. 11. Billing E-mail (For Annual Fee correspondence) ralph@ralphhodge.com Default is legally responsible person e-rrail 12. Billing (For Annual Fee correspondence) Telephone 252-237-8134 Default is legally responsible person telephone State / Rovince / Region NC Country us D. E&SC Plan Part D. ^ Erosion & Sediment Control (E&SC) Ran Approval Information ...................................................................................................................................................................................................................................................................................................................................... 1. Date E&SC Plan 02/23/2021 Approved * 2. E&SC Plan Project COW# 21-06 Number/ID * Assigned by agency or local program 3. E&SC Plan f State DEQ Office Approved by* r Local Program 4. Local Program* City of Wilson Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a complete application. Please also upload a site map showing the overall extent of the project (for linear projects, can include the beginning point and end point coordinates in the "Notes" box below). 5. E&SC Plan S&E Approval Letter.pdf Approval letter or Mast beRDFformat Grading Permit 6. Site Location Map Mist be RDFforrret (lint 20 NB) 563.62KB Location Map.pdf 1.61 MB Rease do not upload entire set of E&SC plans. 7. Notes (Optional) Frovide any additional information that night help the reviewer better understand how uploaded docurrents support the application. Include additional waterbodies if necessary. 8. NOI Certification Hodge eNOI.pdf 580.31KB Form Wst be RDFforrret This is an Express r No Review Project* r Yes E. Certification North Carolina General Statute 143-215.66 (1) provides that: Any person who knowingly makes anyfalse statement, representation, or certification in any application, record, report, plan, or other document filed or required to be maintained under this Article or a rule implementing this Atide; or who knowingly makes a false statement of a material fact in a rulemaking proceeding or contested case under this Atcle; or who falsifies, tampers with, or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained under this Amide or rules of the Commission implementing this Atcle shall be guilty ofa Class 2 misdemeanor which may include a fine not to exceed ten thousand dollars ($10,000). Under penalty of law, I certify that: 17 I am the person responsible for the construction activities of this project, for satisfying the requirements of this permit, and for any civil or criminal penalties incurred due to violations of this permit. rJ The information submitted in this NOI is, to the best of my knowledge and belief, true, accurate, and complete based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information. * 17 I will abide by all conditions of the NCG010000 General Permit and the approved Erosion and Sediment Control Plan. * rJ If the Erosion and Sediment Control Plan approved by the delegated program is not compliant with Part II (Stormwater Pollution Prevention Plan) of the NCG010000 General Permit. I will nonetheless ensure that all conditions of Part II of the permit are met on the project at all times. * 17 I hereby request coverage under the NCG010000 General Permit and understand that coverage under this permit will constitute the permit requirements for the discharge(s) and is enforceable in the same manner as an individual permit. Specify if you are:* r The Legally Responsible Person named on this Notice of Intent f Authorized Responsible Person' (signing on behalf of Legally Responsible Person named in Part B) Important: The person who electronically signs this Certification above must be the same person who signs the NOI Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible person within the same organization as the Permittee. *An authorized individual is a responsible corporate officer who owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part IV, Section B, Item (6) of that permit. Signature Type Name* Ralph Hodge Title President Organization Legally Ibsponsible Entity Sleepy Hollow Development Company Date * 02/24/2021 F. Tracking and COC Info NOI Tracking No. 45298 NC Reference No. NCG01-2021-1143 Uses 'count_nurrber' variable (increrrented by SP) Certificate of NCC211143 Coverage (COC) Uses 'count_nurrber' variable (increrrented by SP) No.* Count Number 1143 Sequential nurrber for subrrittal that is incremented by Stored Frocedure COC Year 2021 Year of date reviewed (used to assign YY digits after "NOC' in COCno.) Initial Invoice No. NCC211143-2021 Invoice Due Date 3/27/2021 Initial Fee $ 100.00 Invoice Status OPEN